Audiology Research

Background: Benign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder and most frequently involves the posterior semicircular canal (PSC). Atypical apogeotropic variants of PSC-BPPV may present with pure down-beating positional nystagmus, mimicking contralateral anterior semicircular canal involvement and resulting in diagnostic and therapeutic uncertainty. Objective: To assess the effectiveness of the Bascule/Pendular maneuver in managing patients with pure down-beating positional nystagmus and suspected apogeotropic PSC-BPPV. Methods: A total of 178 patients presenting with pure down-beating positional nystagmus without a torsional component were evaluated using a standardized diagnostic protocol under video-Frenzel goggle monitoring. All patients underwent the Bascule/Pendular maneuver, a modification of the classical Semont maneuver designed to mobilize otoconial debris along the vertical canal planes (Left Anterior–Right Posterior and Right Anterior–Left Posterior), regardless of precise lateralization. Conversion of nystagmus from the apogeotropic to the geotropic variant was considered the primary outcome. Results: The maneuver was well tolerated, with no procedural interruptions or complications. Immediate conversion to the geotropic variant was achieved in 86 patients (48.3%) after a single maneuver. In the remaining patients, successful conversion was obtained after additional maneuvers, most commonly following a second application on the contralateral plane. Once geotropization was achieved, all patients were successfully treated using a standard posterior canal repositioning maneuver. Conclusions: The Bascule/Pendular maneuver is a practical and effective approach for patients presenting with pure down-beating positional nystagmus and suspected apogeotropic PSC-BPPV. By facilitating conversion to the geotropic form, it allows prompt treatment with conventional repositioning maneuvers and may represent a useful first-line strategy in atypical BPPV presentations.

Background and objectives: Stapedotomy is the surgical treatment for otosclerosis, with excellent results in terms of hearing recovery. Various laser systems have proven to be an interesting alternative to the conventional technique, allowing for a more precise footplate fenestration with apparently less trauma to the inner ear. The diode laser, more recently introduced, seems to offer more controlled tissue interaction, potentially reducing thermal damage to surrounding structures. However, the literature remains limited. The aim of the present study was to evaluate the functional outcomes and clinical safety of diode laser stapedotomy by comparing the observed results with those previously reported. Materials and methods: A retrospective analysis of 105 patients who underwent diode laser stapedotomy was conducted. The audiological data and the complications were analyzed and compared with a cohort of patients who underwent stapedotomy performed using the conventional technique. Results: In patients who underwent diode laser stapedotomy, the postoperative air–bone gap (ABG) improved significantly at all frequencies. Hearing outcomes were excellent (ABG ≤ 10 dB) in 60.9% of cases, good (ABG ≤ 20 dB) in 89.5%, and poor (ABG > 20 dB) in 10.5% of patients. Intraoperative complications occurred in seven patients (6.7%), including two cases (1.9%) of footplate damage. Postoperatively, 13 cases of vertigo (12.4%), three cases of tinnitus (2.8%), and one case of sensorineural hearing loss (0.9%) were reported. Conclusions: Diode laser stapedotomy is an effective and safe procedure, providing excellent audiological outcomes without increasing the risk of surgical complications. The possibility of thermal damage to the inner ear must be considered, and appropriate laser parameters should be used to minimize these risks.

Background: The vestibular system encodes head motion through specialized Type I and Type II hair cells, which differentially respond to acceleration and its temporal derivative, jerk. Molecular gradients of retinoic acid establish zonal distributions of these hair cells, prefiguring their functional specialization. Objectives & Methods: Here I integrate developmental, synaptic, biomechanical, and neural evidence to propose that Type I hair cells, via multimodal synaptic transmission, are particularly well suited for ultrafast detection of transient inertial deformation (jerk), whereas Type II cells play a greater role in encoding sustained acceleration through viscous-flow mechanisms. Molecular gradients of retinoic acid help establish central–peripheral zonal patterning in the otolith and canal epithelia, which in turn underlies differential mechanical and synaptic specialization rather than a simple redistribution of hair-cell types. Computational and experimental studies reveal that the vestibular organs operate in dual mechanical regimes, enabling the dynamic encoding of motion onset and continuity. In systems terms, these viscous and inertial activation modes correspond to distinct temporal filters, whose different time constants naturally give rise to distinct frequency responses. What has traditionally been described as ‘low- vs. high-frequency’ tuning therefore emerges as the frequency-domain signature of acceleration- versus jerk-sensitive pathways. Conclusions: This hierarchical organization elucidates the selective activation observed in clinical vestibular tests and informs novel diagnostic and rehabilitative strategies targeting specific receptor pathways. Together, these findings redefine vestibular transduction as a multimodal dynamic sensor, enhancing our understanding of balance and spatial orientation under complex motion conditions.